Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

Abstract

Purpose Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. Methods The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. Results The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were − 1.6 (95% CI .2.6 to − 0.5) degrees and − 9.6 (95% CI − 16.0 to − 3.3) mm. Conclusions It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.

Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression

“…[16][17][18][19][20][21] However, these studies provided limited evidence on improvements of SSPA and showed various patterns of improvements. 4 Lower back pain in patients with LSS is presumably caused by buckling of the ligamentum flavum that impinges on the spinal nerves, thus impeding blood supply. This phenomenon is counteracted by flexion of the lumbar spine, which stretches the ligamentum flavum, thereby releasing the impingement causing apparent malalignment.…”

“…limited evidence to support this phenomenon, and disagreements between patterns of change in SSPA parameters still exist. 4 Clinical symptoms of LSS vary widely. Most patients present with neurogenic intermittent claudication, which is aggravated during various periods of standing and walking.…”

“…However, there is limited evidence to support this phenomenon, and disagreements between patterns of change in SSPA parameters still exist. 4…”

Spinal stability analysis of lumbar interbody fusion according to pelvic type and cage angle based on simplified spinal model with various pelvic indices

“…In the study of Hatakka (Hatakka et al, 2021), in conclusion, the quality of the evidence on the effect of decompressive surgery for spinal-pelvic alignment was low, and there was substantial heterogeneity of the study design among the studies included. In addition, few studies have been conducted on the correlation of sagittal parameters according to LIF for each pelvic type.…”

Commentary: Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression

“…Previous studies evaluating the role of decompression surgery on sagittal alignment parameters have at best demonstrated a small, statistically significant but probably clinically insignificant effect on sagittal alignment parameters. 2 Most of those studies, however, focused on the presence of LSS rather than symptoms such as pain as was performed in this study. By evaluating the presence of painful degenerative conditions and demonstrating that the SSPA parameters do improve in this patient population as compared with the more general LSS population, the results provide more granularity and data addressing this interesting topic.…”